Wednesday, January 18, 2012

An interesting pairing of letters to the editor of the National Post on the topic of electronic cigarettes illustrates the stark contrast between the ivory tower thinking of anti-smoking ideologues and the real-life experience of actual smokers whose lives are at stake.

In the first letter, Stan Shatenstein (contributing editor of the journal Tobacco Control) argues that electronic cigarettes should not be allowed on the market at the present time because of uncertainty about their absolute health risks, even though the fact that these products reduce the carcinogenic risk from cigarette smoking is "obvious." He writes:

"Against the obvious reduction in carcinogens must be calculated the risk that smokers will use e-cigarettes to get themselves through times when they can’t smoke, and that sustaining the hand-to-mouth habit will induce a return to “real” cigarette smoking. It is utterly scurrilous for Mr. Kline to argue that e-cigarettes have not received regulatory approval because the government “has become addicted to the lucrative tobacco industry.” We are now facing the prospect of one billion — yes, billion with a “b” — lives lost prematurely to tobacco use this century, the majority in developing countries. If e-cigarettes have to pass some regulatory hurdles before they’re allowed on the market, we should be grateful to the government for its due diligence."

In the second letter, a former smoker who quit smoking and has remained smoke-free for the past years thanks to electronic cigarettes, shares his experience:

"Thanks to Jesse Kline for his column on e-cigarettes. I smoked for 45 years and never could quit for more than three months with conventional smoking cessation methods. With the e-cigarette, I quit smoking almost immediately and I have not had as much as a puff from a regular cigarette in almost two years. It is very refreshing to see Mr. Kline’s common sense column on this subject."

The Rest of the Story

The contrast in these letters is emblematic of the conflict between the ivory tower ideology of the anti-smoking movement - which wants to see costly and time-consuming clinical trials before it concludes that smoking is more harmful than vaping - and the reality of the lives of the millions of real people who are addicted to smoking, cannot easily quit, and have been largely unhelped by the dismal effectiveness of FDA-approved smoking cessation products, which have about a 92% long-term failure rate.

To adapt an analogy first made by Jacob Sullum, the anti-smoking ideologues would advise victims of a shipwreck not to use the lifeboats because they haven't been fully tested to ensure their safety. And if thousands of victims of that shipwreck were successfully keeping afloat because of the lifeboats, the anti-smoking ideologues would advise them to abandon the lifeboats and stick to "government approved" survival methods.

If we lived in a different world - one in which electronic cigarettes were not yet on the market and therefore were not being successfully used by thousands of ex-smokers to remain off cigarettes - then the anti-smoking ideology would be appropriate: don't introduce the products into the market until they have been thoroughly tested.

But that's not the world we live in. The reality is that these products are already on the market and have been for at least four years. Several million smokers are using them, and literally thousands are using them successfully to keep off tobacco cigarettes. To ban these products from the market would be equivalent to forcing most of these thousands of ex-smokers to return to smoking. That would have devastating health consequences.

Anti-smoking groups and advocates need to go beyond the confines of their ivory tower ideology and start talking to the people they are supposedly trying to help: people who live in the real world, one in which existing smoking cessation products are highly ineffective and in which electronic cigarettes are filling a void by offering a cessation device that replaces the behavioral and physical stimuli of cigarette smoking, not just the pharmacologic reinforcement.

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About Me

Dr. Siegel is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. He has 32 years of experience in the field of tobacco control. He previously spent two years working at the Office on Smoking and Health at CDC, where he conducted research on secondhand smoke and cigarette advertising. He has published nearly 70 papers related to tobacco. He testified in the landmark Engle lawsuit against the tobacco companies, which resulted in an unprecedented $145 billion verdict against the industry. He teaches social and behavioral sciences, mass communication and public health, and public health advocacy in the Masters of Public Health program.